BMC Cancer (Oct 2018)

Feasibility of concomitant cisplatin with hypofractionated radiotherapy for locally advanced head and neck squamous cell carcinoma

  • Alexandre Arthur Jacinto,
  • Eronides Salustiano Batalha Filho,
  • Luciano de Souza Viana,
  • Pedro De Marchi,
  • Renato de Castro Capuzzo,
  • Ricardo Ribeiro Gama,
  • Domingos Boldrini Junior,
  • Carlos Roberto Santos,
  • Gustavo Dix Junqueira Pinto,
  • Josiane Mourão Dias,
  • Heloisa Pelisser Canton,
  • Raiany Carvalho,
  • Lucas Augusto Radicchi,
  • Soren Bentzen,
  • Eduardo Zubizarreta,
  • Andre Lopes Carvalho

DOI
https://doi.org/10.1186/s12885-018-4893-5
Journal volume & issue
Vol. 18, no. 1
pp. 1 – 9

Abstract

Read online

Abstract Background The evolution of radiotherapy over recent decades has reintroduced the hypofractionation for many tumor sites with similar outcomes to those of conventional fractionated radiotherapy. The use of hypofractionation in locally advanced head and neck cancer (LAHNC) has been already used, however, its use has been restricted to only a few countries. The aim of this trial was to evaluate the safety and feasibility of moderate hypofractionated radiotherapy (HYP-RT) with concomitant cisplatin (CDDP). Methods This single-arm trial was designed to evaluate the safety and feasibility of HYP-RT with concomitant CDDP in LAHNC. Stage III and IV patients withnonmetastatic disease were enrolled. Patients were submitted to intensity modulatedradiation therapy, which comprised 55 Gy/20 fractions to the gross tumor and44–48 Gy/20 fractions to the areas of subclinical disease. Concomitant CDDPconsisted of 4 weekly cycles of 35 mg/m2. The primary endpoints were the treatment completion rate and acute toxicity. Results Twenty patients were enrolled from January 2015 to September 2016, and 12 (60%) were classified as unresectable. All patients completed the total dose of radiotherapy, and 19 patients (95%) received at least 3 of 4 cycles of chemotherapy. The median overall treatment time was 29 days (27–34). Grade 4 toxicity was reported twice (1 fatigue and 1 lymphopenia). The rates of grade 3 dermatitis and mucositis were 30% and 40%, respectively, with spontaneous resolution. Nasogastric tubes were offered to 15 patients (75%) during treatment; 4 patients (20%) needed feeding tubes after 2 months, and only 1 patient needed a feeding tube after 12 months. Conclusion HYP-RT with concomitant CDDP was considered feasible for LAHNC, and the rate of acute toxicity was comparable to that of standard concomitant chemoradiation. A feeding tube was necessary for most patients during treatment. Further investigation of this strategy is warranted. Trial registration ClinicalTrials, NCT03194061. Registered 21 Jun 2017 – Retrospectively registered.

Keywords